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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
-- ".,..,'N9TI{t.E OF INHERITANCE TAX
,Y{~("::-'Aep.gA-rS€'iiEN", ALLOWANCE OR DISALLOWANCE
' ','.. OF DE:DUOnONS, AND ASSESSMENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
*'
2Q01 JM.j 15 Prl 12: 0 I
KAREN J MARCH
3755 MOUNTAIN VIEW
MECHANICSBURG PA 17050
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REV-1548 EX AFP (06-05)
DATE 01-15-2007
ESTATE OF PETERSON RICHARD N
DATE OF DEATH 07-17-2006
FILE NUMBER 21 06-1101
COUNTY CUMBERLAND
SSN/DC 086-20-0896
ACN 06153176
APPEAL DATE: 03-16-2007
(See reverse side under Objections)
Amount Remitted I I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS 4--
REY:is4i-EX-AFP-C03:0Sj---------------------------_________________________________________
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 01-15-2007
ESTATE OF PETERSON
RICHARD
N DATE OF DEATH 07-17-2006
S.S/D.C. NO. 086-20-0896
ex) ACCEPTED AS FILED e) CHANGED
JOINT OR TRUST ASSET INFORMATION
FILE NO. 21 06-1101
TAX RETURN WAS:
FINANCIAL INSTITUTION: MEMBERS 1ST FCU
TYPE OF ACCOUNT:
DATE ESTABLISHED
COUNTY
CUMBERLAND
ACN
06153176
ACCOUNT NO.
118029- 63
e )SAVINGS e) CHECKING e HRUST OC )TIME CERTIFICATE
02-06-2006
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
X
25,555.30
0.166
4,259.30
.00
4,259.30
.45
191.67
X
TAX CREDITS:
PAYMENT
DATE
11-30 -2006
RECEIPT
NUMBER
CDo07559
DISCOUNT e+)
INTEREST/PEN PAID e-)
.00
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
AMOUNT PAID
191.67
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. *
{ IF TOTAL DUE IS LESS THAN *1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
191.67
.00
.00
.0